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Effectiveness: Heart Disease

2010 National Healthcare Quality and Disparities Reports

The National Healthcare Quality Report (NHQR) is a comprehensive national overview of quality of health care in the United States. It is organized around four dimensions of quality of care: effectiveness, patient safety, timeliness, and patient centeredness.

Prevention of Heart Disease

Measure Title

Adults who received a blood pressure measurement in the last 2 years and can state whether their blood pressure was normal or high.

Measure Source

Healthy People 2010.

National Tables

4_1_1.1 Adults who received a blood pressure measurement in the last 2 years and can state whether their blood pressure was normal or high, United States, 1998, 2003, and 2008

4_1_1.2a-c Adults who received a blood pressure measurement in the last 2 years and can state whether their blood pressure was normal or high, United States, 2008, by:

Race.

Ethnicity.

Family Income.

National Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health Interview Survey (NHIS).

Denominator

U.S. adult population age 18 and over.

Numerator

Subset of the denominator who had their blood pressure measured within the preceding 2 years and can state their blood pressure level.

Comments

This measure is measure 12-12 in Healthy People 2010. Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5, of Tracking Healthy People 2010.

Prevention of Heart Disease

Measure Title

Measure Source

National Table

4_1_2.1 Adults with hypertension whose blood pressure is under control (less than 140/90 mm Hg), United States, 2001-2004, and 2005-2008

National Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health and Nutrition Examination Survey (NHANES).

Denominator

U.S. civilian noninstitutionalized population age 18 and over who either have elevated blood pressure (average systolic pressure of at least 140 mm Hg or average diastolic pressure of at least 90 mm Hg) and who are taking antihypertensive medication.

Numerator

Subset of denominator taking antihypertensive medication with average systolic blood pressure less than 140 mm Hg or average diastolic blood pressure less than 90 mm Hg based on average of three measurements.

Comments

Estimates are age adjusted to the 2000 standard population using three age groups: 18-39, 40-59, 60 and over.

This measure is referred to as measure 12-10 in Healthy People 2010 documentation.

Prevention of Heart Disease

Measure Title

Adults who received a blood cholesterol measurement in the last 5 years.

Measure Source

Healthy People 2010.

National Tables

4_1_3.1 Adults who received a blood cholesterol measurement in the last 5 years, United States, 1998, 2003 and 2008

4_1_3.2a-c Adults who received a blood cholesterol measurement in the last 5 years, United States, 2008, by:

Race.

Ethnicity.

Family Income.

National Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health Interview Survey (NHIS).

National Denominator

U.S. adult population age 18 and over.

National Numerator

Subset of denominator who have had their cholesterol checked within 5 years.

State Table

4_1_3.4 Adults age 18 and over who have had their blood cholesterol checked within the preceding 5 years, by State, 2001-2005 and 2007

State Data Source

CDC, Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5, of Tracking Healthy People 2010.

This measure is referred to as measure 12-15 in Healthy People 2010 documentation.

Measure Source

National Table

4_2_1.1 Hospital patients with heart attack and left ventricular systolic dysfunction who were prescribed ACE inhibitor or ARB at discharge, United States, 2005-2008

National Data Source

CMS, QIO.

National Denominator

Discharged hospital patients with a principal diagnosis of acute myocardial infarction (AMI), and documented left ventricular ejection fraction, and without contraindication for ACE inhibitors or angiotensin receptor blockers.

National Numerator

Subset of the denominator prescribed an ACE inhibitor or ARB at hospital discharge.

State Table

4_2_1.2 Hospital patients with heart attack and left ventricular systolic dysfunction who were prescribed ACE inhibitor or ARB at discharge, by State, 2005-2008

State Data Source

CMS, QIO.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

The measure criteria exclude patients under age18, patients transferred to another acute care or Federal hospital, patients who expired, patients who left against medical advice, patients discharged to hospice, and patients with certain conditions or contraindications pertaining to the medications described in the measure. Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

State Data Source

State Denominator

State Numerator

Comments

Rates are adjusted by age, gender, age-gender interactions, and all patient refined-diagnosis related group risk of mortality score. Transfers to another hospital are excluded.

This table was created using version 3.1 of the AHRQ IQI software. This measure is referred to as IQI 15 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the Nationwide Inpatient Sample is weighted to give national estimates using weights based on all U.S. community, nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

The SID disparities analysis file, created specifically for the NHQR/NHDR to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 26 States that participate in HCUP and have high-quality race/ethnicity data: AR, AZ, CA, CO, CT, FL, GA, HI, KS, MA, MD, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, UT, VA, VT, WI, and WY.

Treatment of Heart Failure

Measure Title

Hospital patients with heart failure who received recommended hospital care—evaluation of left ventricular ejection fraction and angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) at discharge, if indicated, for left ventricular systolic dysfunction.

National Data Source

National Denominator

National Numerator

Subset of denominator who received recommended processes during the hospital stay: evaluation of left ventricular ejection fraction and an ACE inhibitor or ARB prescription at hospital discharge.

State Table

4_3_1.2 Hospital patients with heart failure who received recommended hospital care—evaluation of left ventricular ejection fraction and ACE inhibitor or ARB prescription at discharge, if indicated, for left ventricular systolic dysfunction, by State, 2005-2008

This is a composite measure. Recommended hospital care for heart failure includes receiving evaluation of left ventricular ejection fraction and prescription of ACE inhibitor or ARB at discharge for patients with left ventricular systolic dysfunction.

National Data Source

National Denominator

National Numerator

Subset of heart failure patients with documentation in the hospital record that left ventricular ejection fraction was assessed before arrival or during hospitalization or was planned for after discharge.

State Table

4_3_2.2 Hospital patients with heart failure who received an evaluation of left ventricular ejection fraction, by State, 2005 -2008

State Data Source

State Denominator

State Numerator

Subset of denominator admitted in the hospital for congestive heart failure.

Comments

Measure excludes patients with cardiac procedures, obstetric conditions, and transfers from other institutions.

Estimates of the civilian population, including institutionalized persons, are from unpublished tabulations developed by the Population Division, U.S. Census Bureau, using estimates as of July 1 of the period of study, and are based on the 2000 census.

Data are age adjusted to the 2000 standard population using the age groups under 18 years, 18-44, 45-64, 65-74, and 75 years and over. Age-adjusted rates are weighted sums of age-specific rates.

This measure is referred to as measure 12-6 in Healthy People 2010 documentation. The age range has been modified from the original specification.

State estimates are from the SID, and not all States participate in HCUP. Estimates for the total U.S. are from the Nationwide Inpatient Sample, which is drawn from the SID and weighted to give national estimates.

State Data Source

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Rates are adjusted by age, gender, age-gender interactions, and all patient refined-diagnosis related group risk of mortality score.

This measure was estimated using version 3.1 of the AHRQ IQI software. This measure is referred to as IQI 16 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community, nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

The SID disparities analysis file, created specifically for the NHQR/NHDR to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 26 States that participate in HCUP and have high-quality race/ethnicity data: AR, AZ, CA, CO, CT, FL, GA, HI, KS, MA, MD, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, UT, VA, VT, WI, and WY.

National Data Source

National Denominator

Hospital inpatient discharges with an AAA repair procedure (ICD-9-CM codes 38.34, 38.44, 38.64, and 39.71) in any procedure field and a diagnosis code of AAA (ICD-9-CM 44.13, 44.14) in any field, excluding obstetric and neonatal admissions and transfers to another hospital.

State Data Source

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Rates are adjusted by age, gender, age-gender interactions, and all patient refined-diagnosis related group risk of mortality score. This measure was estimated using version 3.1 of the AHRQ IQI software. This measure is referred to as IQI 11 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community, nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

The SID disparities analysis file, created specifically for the NHQR/NHDR to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 26 States that participate in HCUP and have high-quality race/ethnicity data: AR, AZ, CA, CO, CT, FL, GA, HI, KS, MA, MD, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, UT, VA, VT, WI, and WY.

State Data Source

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Rates are adjusted by age, gender, age-gender interactions, and all patient refined-diagnosis related group risk of mortality score.

This measure was estimated using version 3.1 of the AHRQ IQI software. This measure is referred to as IQI 12 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community, nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

The SID disparities analysis file, created specifically for the NHQR/NHDR to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 26 States that participate in HCUP and have high-quality race/ethnicity data: AR, AZ, CA, CO, CT, FL, GA, HI, KS, MA, MD, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, UT, VA, VT, WI, and WY.

National Data Source

National Denominator

Hospital inpatient discharges, age 40 and over, with PTCA (ICD-9-CM codes 00.66, 36.01, 36.02, or 36.05) in any procedure field, excluding obstetric and neonatal admissions and transfers to another hospital.

National Numerator

Subset of denominator who died.

State Table

4_4_3.3 Deaths per 1,000 admissions with PTCA, age 40 and over, by State, 2000, 2004-2007

State Data Source

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Rates table are adjusted by age, gender, age-gender interactions, and all patient refined-diagnosis related group risk of mortality score. This measure was estimated using version 3.1 of the AHRQ IQI software. This measure is referred to as IQI 30 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community, nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

The SID disparities analysis file, created specifically for the NHQR/NHDR to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 26 States that participate in HCUP and have high-quality race/ethnicity data: AR, AZ, CA, CO, CT, FL, GA, HI, KS, MA, MD, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, UT, VA, VT, WI, and WY.